I.StatementoftheProblemtobeStudiedOnSeptember21,1989, hurricane Hugo came ashoreatCharleston, South Carolina. A category V hurricane, Hugo ravaged the coastline with sustained winds of135mph and tidal surges15to 20 feet above high tide. Not only was Hugo oneofthe most powerful storms to hit the continental U.S., but also one of the largest. Hurricane force winds radiated 100 miles from its center, and tropical force winds extended 200 miles from the eye. Consequently, the damage causedbyHugo was unprecedented: approximately 3 million people were affected;26lives were lost; and343people were injured. Seventeen thousand people were left jobless; over 5,300 homes were destroyed; and another 18,000 homes were rendered uninhabitable. In the Charlestonareaalone, property damage estimates were in excess of$4billion. Although the estimated losses are impressive, the negative psychological effects of a disaster of this magnitude are more difficult to describe and understand. Some helpinthis regardisprovidedbythe Diagnostic and Statistical Manual of Mental Disorders Revised (DSM-III-R) which describes the psychological sequela of trauma and recognizes Post-traumatic Stress Disorder (PTSD)asa diagnostic category. In the DSM-III-R framework, PTSD symptomatology includes: recurrent and intrusive recollections of the traumatic event (e.g., recurrent dreams, flashbacks); avoidance of stimuli associated with the traumaornumbingofresponsiveness (e.g., inability/refusal to recall details of the event, diminished interest in significant activities); and increased arousal (e.g., sleep disturbances, irritability, inability to concentrate). Associated complications of PTSD include depression, anxiety, and increased substance use. Hence, following a disasteritseems important to monitor acute PTSD symptoms as well as identify groupsofpeople who are at increased risk for long-term problems stemming from the disaster. Although the DSM-III-R describes the psychological sequelaofdisasters, it does little to helpusunderstand these reactions. Indeed, most of the studies investigating psychological reactions to disasters (e.g., Lystad,1985;Hartsough, 1985) have been hamperedbythe absence of a conceptual model of how stress reactions occur. Moreover, this lack of an adequate conceptual model represents a seriousflawin the stress literatureinthat theoretical models provide an important framework to guide research, increase our conceptual understanding of clinical problems, and improve our ability to provide clinical services. Fortunately, this shortcominginthe stress literature has recently been addressedbyHobfoll (1988) who proposed a theoretical model for conceptualizing stress and stress reactions. The model, called the Model of ConservationofResources,isbased on the supposition that people strive to retain, protect, and build resources. The model identifies four types of resources: object resources (e.g., property, material belongings); conditions (e.g., marriage, job roles); personal characteristics (e.g., self-esteem, sense of control); and energies (e.g., time, money).Anevent or situationisdefined as stressful if these resources.

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2are threatenedorlost. According to this model, the impact a stressful event has on an individualisrelated to the perceivedoractual loss of resources, how essential these resourcesarefor the individual's survival, and the individual's coping style. Because the Conservation of Resources Model proposed by Hobfoll represents an important advance in the stress literature, the proposed study applied this model in order to investigate the psychological sequelaofhurricane Hugo. Specifically, the project sought to determine whether hurricane-related losses suffered by the students and faculty of the Medical UniversityofSouth Carolina affected their reportsofPTSD symptomatology, depression, anxiety, alcohol and substance use, and other health-risk behaviors (e.g., diet and exercise) following Hugo.ll.Research Questions tobeAnswered The overall goal of this project was to generate empirical data which would allowusto evaluate the applicabilityofHobfoll's theoretical modelofstress for predicting psychological response to natural disasters. In order to accomplish this goal, the following specific objectives for the project were identified: A. To describe and quantify the symptoms of psychological distress experiencedbyour sample following hurricane Hugo.B.To describe and quantify the typesoflosses sufferedbyour sampleasa resultofHugo.C.To determine whether resource loss was correlated with psychological distress and/or coping behavior. D.Toidentify variables that were predictive of psychological distress following Hugo and determine which variables among resource loss, personal characteristics, and coping behaviors were most predictive of distress.E.Todetermine whether high resource loss compared tolowresource loss,wasassociated with greater prevalence of clinically significant psychological distress following hurricane Hugo. F.Todetermine which types of resource loss were most important in explaining psychological distress following hurricane Hugo. G. To determine the effect of gender on self-reported resource 19ss following Hugo.

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3H.Todetermine whether psychological distress following hurricane Hugo was effected by genderorthe extentoflossofresources.I.Toprovide normative data about the patternsofalcohol and medication use by our sample after hurricane Hugo.J.Toidentify subject variables (e.g., gender and pre-Hugo drinking patterns) that were associated with increased useofalcohol and medications following hurricane Hugo.K..Tocollect normative data that documents changes in health habits following hurricane Hugo.L.Todetermine whether gender and the extentofloss of resources were associated with disruptioninhealth-related behaviors following Hugo.ill.Methodologyofthe Study A. Methods: Approximately eight weeks after hurricane Hugo struck Charleston, South Carolina, 1,200 facultyofthe Medical UniversityofSouth Carolina (MUSC) in Charleston were sent via the campus mail, a packetofassessment instruments. Included in the packet was a cover letter that explained the purpose of the study, insured confidentiality, and provided instructions on completing the questionnaires. Eight weeks after Hugo struck, the same packetofinformation was distributed to275MUSC students during their class time. Individuals who completed the survey were given the opportunity to enter a drawing for two gourmet dinners valued at $120. Return envelopes and an entry form for the drawing were also included in the packet.B.Assessment instruments (See Appendix I for a copyofeach assessment instrument.) :1.Demographic questionnaire. This questionnaire provided basic demographic information about the subjects including their sex, race, marital status, education level, and annual income.Italso provided information about previous exposuretoother natural disasters, dollar value of property lost as a result of the hurricane, and the respondent's whereabouts when the hurricane actually struck.2.Resource Loss Questionnaire. Hobfoll's original Resource Loss Questionnaire (RLQ) was modified to obtain a 52-item self-report

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4inventory on which subjects useda4-point Likert scale to rate the extent to which Hugo resulted in the loss or threatened loss of 52 resources (e.g., property, money, self-esteem, and leisure time). Although the scale yields a separate score for each typeofresource identified by Hobfoll (i.e., Objects, Conditions, Personal Characteristics, and Energies), the total resource loss score (unless specified otherwise) was used in thedataanalyses.3.COPEQuestionnaire. This 60-item self-report inventory provides154-item scales (Carver, Scheler, and Weintraub, 1989). Subjects used a 4-point Likert scale to indicate the extent to which they had used, after the hurricane, each of the60coping behaviors listed. A ratingof0 indicated that they had not used that behavior "atall,"and a rating of 3 indicated they had used the behavior "a lot."Thesubjects' scores for each of the15scales were used as raw data for a principle component factor analysis with Varimax rotation to produce the three coping factors used in this study: problem-focused coping, emotion focused coping, and disengagement copying.4.Symptom Checklist-90 Revised (SCL-90-R). This 90-item self-report questionnaire devised by Derogatis (1983) was used by subjects to report on a 5-point Likert scale the extent to which they experienced90symptoms (e.g., headaches, feelingsofguilt, trembling, and feeling blue) following hurricane Hugo.TheGlobal Severity Index score from the SCL-90-R was used in the data analysesasa measure of overall psychological distress following hurricane Hugo.5.Health Habits Questionnaire.Wedeveloped this 52-item questionnaire to evaluate weight changes, food choices, eating patterns, exercise patterns, alcohol use, and prescription medication use following hurricane Hugo.N.Sample Characteristics A Faculty Sample1.Size of sample: 525; response rate=43%.2.Gender: 51% male; 49% female.3.Age: mean age=40.46 years; range=19to77years.

1110.Objective H:Todetermine whether psychological distress following hurricane Hugo was effectedbythe extentoflossofresources, a median split was performed on the Resource Loss Questionnaire total scores to define a high loss and low loss group. The mean GSI T -score for the low loss group was45whereas the mean GSI T -score for the high loss group was 57. A t-test applied to these data indicated that significantly more distress on the SCL-90-R was reportedbythe high loss group compared to the low loss group (t( 472)=14.03,p
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12c) Males who drank more than 8 drinksperweek prior to the hurricane reported a higher rateofincreased intakeofalcohol (47%) than any other group. d) A higher percentage of females compared to males reported starting a prescription medication following hurricane Hugo. e) A higher proportionofhigh loss females compared to other groups reported an increase in prescription medication use following Hugo.f)A higher proportionofhigh loss females compared to other groups reported an increase in over-the-counter pain medication and antihistamine use following the hurricane. g) Genderorloss group did not appear to affect increases in over-the counter cold medication use.13.ObjectiveK:Normative data which describe the health-related characteristicsofour faculty sample and the changes in health habits our sample made following hurricane Hugo are reported in Tables 1-5 in AppendixV.Perusalofthe data shown in these tables indicates that the entire sample displayed, on average, increases from preto post-hurricane in snacking (t(520)=7.4,p
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15Table 7 PercentofGSI Variance Accounted forbyEach Predictor Block Contained In the Hierarchical Multiple Regression Analyses for the Faculty and Student Data. Predictor Block Faculty Group Student Group Demographic/Experiential 9.5% 12.8% Resource Loss 34.1% 34.4% Coping Behavior 7.9% 8.9% Total Variance Accounted for 51.5% 56.1% InspectionofTable 7 indicates that for both the faculty and student groups, resource loss was the single best predictor of psychological distress. In addition, demographic/experiential variables accounted for approximately the same amount of variance in GSI scores for the faculty and student groups. Moreover, the total amountofGSI variance accounted for in the hierarchical multiple regression was approximately the same for the two groups (faculty and students) under study.4.Objective E: To assess the role of resource loss as a risk factor for clinically significant psychological distressinthe student group, we used level of resource loss (high, low) as a grouping variable and scores on the General Severity Index (GSI) as a dependent variable. Given known gender differences for SCL-90-R scores, separate analyses were conducted for male and female student participants. Specifically, participants were assigned to the high resource loss group for their gender if their resource loss score was in the uppermost 25.0% of the distribution for their gender. Conversely, the low resource loss groups consistedofindividuals with resource loss scores fallinginthe lowest quartile of the distribution for their gender. Among male students, the high loss group reported significantly greater levelsofpsychological distress (t(68)=3.24,p63).Bycontrast, only6.1% oflowloss males exceeded the cutoff. Among female students, the high loss group, compared to thelowloss group, reported significantly higher

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16psychological distress (t(102)=-5.25,p
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17Both students and faculty with higher losses reported increased consumptionoffast food and a decrease in exercise. Snacking behavior, fast food consumption, skipping meals and changes in exercise were not different between males and females for either the studentorthe faculty populations. Small differences in weight change patterns were noted for both the faculty and students. Across all groups (male versus female and low versus high loss), the mean weight changeinthe student and faculty groups was identical(x=2.3Ibs.). The absolute weight change for male students in the high and low loss groups (2.5Ibs.,2.1Ibs.) was roughly equivalent to high andlowloss faculty (2.8Ibs.,1.71Ibs.). However, in the high loss group, a higher percentage of students reported weight losses (23.5%) than gains (11.7%). This trend was reversed in the faculty data with 16% reporting losses and 21.3% reporting gains. Roughly 20%ofthe low loss males in both populations reported weight gain; 9.1%oflow loss males noted a loss, whereas only 2.9%oflowloss faculty reported a loss. Thus, it appears that male students are more susceptible to losing weight than their older faculty counterparts who were more likely to gain. Female students and female faculty in the high loss groups showed nearly identical patterns of weight change. Fifty-one percentinboth groups reported weight gains, and 18% reported losses. Low loss female students showed smaller absolute weight changes (1.8 Ibs.) than low loss female faculty (3.2 Ibs.). Only 19% oflowloss female students reported weight gains compared to 34.8% of thelowloss female faculty. The most frequently reported obstacles to an exercise routine for both students and faculty were1)lack of time and 2) lack of facilities. Summarizing the comparison of student and faculty data about health related issues, the experience of hurricane Hugo appeared to have affected students and faculty similarly. Unhealthy changes in food consumption, weight, and exercise patterns were noted in both groups. In general, females and high loss persons displayed greater changes. The most notable differences, which couldbeexplained by age, were directionofweight change.

12.Where did you stay during hurricane Hugo? a. own residence b. residenceofa family memberorfriendc.a shelterd.a hoteVmotel e.atworkf.other_13.Whowaswith you during hurricane Hugo? (circle only one)a.no one, Iwasaloneb.family membersorclose friendsc.acquaintancesorco-workersd.other_14.How far from Charleston (the peninsula)wasyour placeofrefuge?a.lessthan25milesb.26 to 100 milesc.101to 150 milesd.over151miles15.Towhat extent did you fear for your safety duringhurricane Hugo? 1 notatall23moderately 45extremely16.To what extent did you sustain physical harmorinjury due to Hugo?1notatall23moderately45extremely17.Towhat extent did your decisions regarding hurricane Hugo place youatrisk for harm? (e.g., where to stay, whenorif to leave, etc.)1not at all23 moderately45extremely18.To what extent did your decisions regarding hurricane Hugo place other peopleatrisk for harm?1not at all 23moderately45extremely19.To what extent didotherpeople make decisions regarding Hugo that placed you at risk for harm? (e.g., job/partner required you to stay) 1 notatall 23moderately 45extremely

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20.Howsoon after Hugo did you see your residence?a.immediatelyb. 1to3daysc.4to6daysd.greater than6days21.Estimatethefinancial costofrepairing damage to your primary residence? (includes structure and contents) a.nocost b. less thanSS,OOOc.SS,001to$20,000d.$20,001to$50,000e.SSO,OOIto$100,000f.over$100,00022How long were you displaced from your primary residence due to Hugo?a.IwasnotdisplacedataUb.less than3daysc.3to7daysd.8to14dayse.15to30daysf.31daysormore, but I am back inmyprimary residenceg.31daysormore and I am not back inmyprimary residence23.How soon after the storm did you return to your placeofemployment? (school for students)a.1to3daysb. 4to 7daysc.greater than 7days24.Have you ever personally experienced a natural disaster prior to Hugo? (hurricane, tornado,flood,earthquake, etc.) Yes__No25.Areyou a nativeofthe Charleston area?Yes__No26.How long have you lived in the Charleston area?a.less than 1 yearb.1 to 5 yearsc.6 to15yearsd.over15years

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RESOURCES QUESTIONNAIREInstructions: Listed below are a numberofthings which make life easier and/or enjoyable. Since hurricane Hugo you may have experienced a lossofmanyofthese resources. Carefully consider each resource and rate theextent to which you have experienced a lossofthat resource since Hugo. Rate [he extentofloss for each resourceonthe following scale:o=no loss 1=a little bitof loss 2=a moderateamountof loss 3=quitc a bitofloss 4= extremc amountof loss 1.Personal transportation2.Homecontents3.Time for adequate sleep4.Sentimental possessions (photo albums, etc.)5.Clothing6.Feeling valuable to others7.Family stability8."Free time"9.Pets10.Vegetation on your property (trees, shrubs, etc.)11.Intimacy with oneormore family members12.Time for work13.Feeling that I am accomplishingmygoals14.A good relationship withmychildren15.Time with loved ones16.Necessary tools for work17.Stamina/endurance18.Adequate food19.A daily routine20.Personal health 21. Sense of optimism22.Necessary appliances for home

26.Do you consider yourself a regular exerciser?12notatall34somewhat5very much so ZT. Ifyou exercise regularly, whattypeofexercise do you engage in most often: (circle one) not a regular exerciser walking running swimming aerobic dance cycling weight trainingother(please specify) About howmany timesper weekdid/doJOuCIeIdse28. BEFOREthe hurricane 19. SINCE the hurricaneD1234567 8910ormoreD1234567 8910ormore30.Whichofthe following has contributed the most to changes in your exercise SINCE the hurricane: (pick one)a.myexercise has not changedb.not enough time to exercisec.not enough energy to exercised.exerciseisnotasimportant to mee.lackofexercisefacilityf.lackofexercise partnerg.other The net several questions ask aboutalmholmnsumption.-A drink" referstoa beer, wine moler, 407..of wine, or drink: mntaining 1oz.ofliquor.3LUsing the following scale, describe your intakeofalcohol SINCE the hurricane. Have you had alcohol:12much less34no change5much more HOw many drinks ofalmholdid/do JOu usually have per week 32.BEFOREthe hurricane 33. SINCE the hurricanea.Da.Db.1-3b.1-3c.4-7c. 4-7 d.8-12d.8-12e.13-16e.13-16f.17or moref.17ormore During the last twoweeks, howmanytimes haeJOu had 34. 1 or 2 drinks 35. 3or4 drinks on one occasion on one occasion (but no more) (but no more)a.nonea.noneb.onceb.oncec.twicec.twiced.3-5timesd. 3-5 timese.6ormoree.6ormore36.5ormore on one occasiona.noneb.oncec.twiced.3-5timese.6ormore

COPEHurricane Hugo produced challenges for eachofus.Weare interested in what you have done to cope withthechallenges createdbyHugo. Your responses should reflect your efforts to cope from immediately after the hurricane until today. Respond to each item according to the scale below. Your response for each item should be written in the spaa corresponding to the item. 1=I have not donethisat all2=I have done this a little bit3=I have donethisa medium amount4=I have donethisa lot1.I have tried to growasa personasaresult of the experience.2.I have turned tomyworkorother substitute activities to takemymind off things.3.I have gotten upset and letmyemotions ouL4.I have tried to get advice from someone about what to do.5.I have concentratedmyefforts on doing something aboutthe challenges.6.I have said tomyself"this isn't real. W 7.I have putmytrustinGod.8.I have laughed aboutthe situation.9.I have admitted tomyselfthat I can't deal with the challenges and quit trying.10.I have restrainedmyselffrom doing anything too quickly.11.I have discussedmyfeelings with someone.12.I have used alcohol or drugs to make myselffeelbetter.13.I have gottenusedto the idea that the hurricane happened.14.I have talked to someone to find out more aboutthe situation.15.I have keptmyselffromgetting distractedbyother thoughts or activities.16.I have daydreamed about things other than this.17.I have gotten upset, and am really aware ofmyfeelings.18.I have sought God's help.19.I have made a plan of action.20.I have made jokes about the situation.21.I have accepted that the hurricanehashappened and that it can't be changed.22.I have held off doing anything about the challenges until the situation permits.23.I have tried to get emotional supportfromfriends or relatives.24.Ihavejustgivenuptrying to reachmygoals.25.I have taken additional action to trytoget rid of the problems.26.Ihavetried to losemyselffor a whilebydrinking alcohol or taking drugs.27.I have refused to believe that Hugohashappened.28.I have letmyfeelingsouL29.I have tried to see Hugo in a different light, to make it seem more positive.30.I have talked to someone who coulddosomething concrete about the challenges.31.I have slept more than usual.32.I have tried to comeupwith a strategy about what to do.33.I have focused on dealing with the challenges, and if necessary let other things slide a little.34.I have gotten sympathy and understandingfromsomeone.35.I have drank alcohol or taken drugs,inorder to think aboutthe situationless.36.I have kidded around about Hugo.

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Continue to answer each item with these response choices: 1=I have not donethisatall2=I have done this a little bit3=I have donethisa medium amount4=I have donethisa lot 37. I have given up the attempt to get what I wanL 38. I have looked for something good in whatishappening. 39. I have thought about how I might best handle the challenges.40.I have pretended that the hurricane hasn't really happened.41.I have made sure not to make matters worsebyacting too soon.42.I have tried hardtoprevent other things from interfering withmyeffortsatdealing with this.43.I have gone to moviesorwatched TV, tothinkabout the situation less.44.I have accepted the realityofthe fact that Hugo happened.45.I have asked people who have had similar experiences what they did.46.I have felt a lotofemotional distress and I found myself expressing those feelings a lot.47.I have taken direct action to get around the challenges.48.I have tried to find comfort inmyreligion.49.I have forced myself to wait for the right time to do something. 50. I have made funofthe situation. 51. I have reduced the amountofeffortPmputting into solving the challenges.52.I have talked to someone abouthowIfeel.53.I haveusedalcoholordrugstohelp me get through the challenges.54.I have learned to live with the hurricane.55.I have put aside other activitiestoconcentrate onthis.56.I have thought hard about what steps to take. 57. I have acted as though it hasn't even happened.58.I have done what has tobedone, one stepata time.59.I have learned something from the experience.60.I have prayed more than usual.